title: Comparison between drug-eluting stents and coronary artery bypass grafting for unprotected left main coronary artery disease: a meta-analysis of two randomized trials and thirteen observational studies.
abstract: OBJECTIVE
  The clinical outcomes for unprotected left main coronary artery (LMCA) between coronary artery bypass grafting (CABG) and drug-eluting stents (DES) are still controversial. The objective was to compare safety and efficacy between DES and CABG for unprotected LMCA.
  
  
  METHODS
  Electronic databases and article references were systematically searched (2000-2010) to access relevant studies.
  
  
  RESULTS
  Fifteen studies with 5,479 patients were finally involved in the present study. The mortality was similar in DES and CABG groups at 1 year [odds ratio (95% confidence interval): 0.71 (0.5-1.03)], 2 years [1.28 (0.93-1.76)], 3 years [0.88 (0.53-1.46)], 4 years [0.46 (0.18-1.17)], and 5 years [1.16 (0.85-1.57)]. No significant difference was found between DES and CABG in the risk of composite endpoint of death, myocardial infarction and cerebrovascular events during 5 years' follow-up [1 year, 0.95 (0.63-1.43); 2 years, 1.34 (0.67-2.57); 3 years, 1.06 (0.59-1.90); 4 years, 0.53 (0.26-1.08); 5 years, 0.83 (0.33-2.07)]. However, the risk of repeat revascularization was significantly higher in the DES group than the CABG group at 1 year [5.00 (2.85-8.77)], 2 years [4.79 (2.72-8.45)], 3 years [5.72 (3.07-10.65)], 4 years [2.16 (1.17-4.01)], and 5 years [5.65 (3.44-9.27)].
  
  
  CONCLUSIONS
  Our meta-analysis indicates that there are no significant differences in the safety between CABG and DES in patients with unprotected LMCA in the 5 years after intervention. But CABG is superior to DES for repeat revascularization.
authors.affiliation: Department of Surgery, Research Center for Cardiovascular Regenerative Medicine, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Zheng
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zheng
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Hou
authors.forename: Shengshou
authors.initials: S
authors.lastname: Hu
mesh_terms: D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome